(navigation image)
Home American Libraries | Canadian Libraries | Universal Library | Community Texts | Project Gutenberg | Biodiversity Heritage Library | Children's Library | Additional Collections
Search: Advanced Search
Anonymous User (login or join us)
Upload
See other formats

Full text of "The care of the eyes and ears / by Richard H. Lewis"

J-/ 



North Carolina State Library 
Rale/gb ran 







) \ 



Digitized by the Internet Archive 

in 2010 with funding from 
State Library of North Carolina 



http://www.archive.org/details/careofeyesearsbyOOIewi 









Chapel Hill ] 

THE 



CARE OF 



The Eyes and Ears. 



BY 



RICHAED H. LEWIS, M. D., 

Member of the State Board of Health, and Surgeon for Diseases of 

the Eye, Ear, and Throat to St. John's Hospital, and to that 

of the Leonard Medical School, Raleigh, N. C. 



WILMINGTON, N.C.: 

PUBLISHED BY THE NORTH CAROLINA BOARD OF HEALTH. 
1886. 



DIAGRAM OF THE EYE IN HORIZONTAL SECTION. 
/ 




S, sclerotic coat; CH, choroid coat; R, retina, or nervous coat, continuous with ON, the 
optic nerve; ML, Macula lutea, or yellow spot, the centre of retina; VH, vitreous 
humor; L, lens; AH, aqueous humor ; I, iris; CM, ciliary muscle ; C, cornea; Ca, con- 
junctiva. 



PREFACE. 



The object of this article, prepared at the request of the State Board 
of Health, is to assist, as far as may be, in preserving in a condition of 
health and usefulness the most important of the senses. 

Eyesight stands easily first in the estimation of all, and Hearing is 
only second to it. Blindness being one of the most frequent causes 
of pauperism, it becomes still more the duty of the guardians of the 
public health to present to the people such information as may help to 
prevent its occurrence than a regard simply for the happiness and 
prosperity of the individual would require. But there are so many 
instances of damage to, and loss of, one or the other of these precious 
senses when they might have been saved by the knowledge of a few sim- 
ple facts, that there is no need to mention the relief of the community 
of a pecuniary burden to show the necessity for such a publication. 

This, then, being intended for those not at all versed in medicine, 
must be as free as possible from the technicalities in which the profes- 
sional man is accustomed to think, and at the same time as brief as 
possible in order to come, together with other necessary publications, 
within the resources of the Board for printing. The difficulties of the 
task are greatly increased by these conditions, but it shall be my en- 
deavor to be as plain and simple as possible, and at the same time as 
concise as a regard for clearness will permit. I trust the kind reader 
will bear these facts in mind. 



217 N. Wilmington St., 
Ealeigh, N. C, May 12, 1886. 



} 



THE CARE OF THE EYES. 



In order to understand and appreciate instructions as to the proper 
method of caring for any organ, it is absolutely necessary to have some 
idea of the nature of that organ. We must therefore, before going 
farther, study for a few minutes the structure of the eye. Reference 
to the diagram in front "will assist greatly in understanding what fol- 
lows. 

The eye is a nearly round ball about seven-eighths of an inch in 
diameter. The walls of the posterior five-sixths of this globe are made 
up of three thin coats, lying one immediately upon the other like the 
layers of an onion. The interior of this part is filled with a rather 
thick, viscid, but perfectly transparent fluid called the vitreous humor. 
The outermost of these three coats or layers is a dense opaque mem- 
brane named the sclerotio, fibrous in structure, something like the ten- 
dons or " leaders," and therefore very strong and tough. Its purpose 
is to preserve the shape of the ball and to protect the more delicate 
structures within. This constitutes " the white of the eye." Next to 
that is the middle coat, or choroid, which is composed of a network of 
blood-vessels, in the meshes of which is deposited a kind of dark pig- 
ment or coloring-matter, the object' of which is to prevent dazzling 
from bright light. The eyes of albinos are very sensitive to light, 
owing to the absence of this coloring-matter in this coat as well as in 
the hair. At its front border this coat is thickened by the addition of 
another element, the ciliary muscle, or muscle of accommodation — a 
structure of great interest and importance to us. Interior to this is 
the third and innermost layer, called the retina. It may for our pur- 
poses be considered an expansion of the optic nerve, which, coming 
from the brain, perforates the first two coats and then spreads out into 
this nervous layer, " like the cup of a tulip on its stem." This is the 
sensitive plate on which the pictures of all objects seen are taken. 

The front of the eyeball is quite different from that portion we have 
been considering. The first thing we notice is a perfectly transparent 
structure (the remaining one-sixth of the whole ball), which appears 

1 



8 THE CARE OP THE EYES AND EARS. 

to be part of a smaller globe, and which seems to be set in the white 
of the eye like a watch-crystal in its rim. This is the cornea. Just 
back of that we observe a very beautiful curtain, which, on account of 
its infinite variety of colors in different individuals, is called the iris — 
that word meaning a rainbow. Near the centre of this curtain is a 
round black spot which is often referred to in common language as " the 
sight of the eye." This is merely a window or opening in the curtain, 
the pupil, through which light enters the eye and out of which we see. 
This window partially opens and shuts automatically in order to regu- 
late the amount of light. The space between the iris and the trans- 
parent cornea is filled with a watery fluid, the aqueous humor. Imme- 
diately behind the iris, suspended in a little sac, is the crystalline lens. 
It is convex or bulging, both in front and behind, and its function is 
to make pictures on the retina of all objects before the eye. 

Covering all of the white of the eye that can be seen, and leaping 
from that over to the lids and lining their under surfaces, becoming 
continuous with the skin at their edges, is an exceedingly thin, trans- 
parent mucous membrane called the conjunctiva. It is this membrane 
which is involved in ordinary simple inflammations of the eye. It is 
lubricated by tears manufactured for the purpose by the lachrymal 
gland at the upper and outer corner, the surplus being carried off by 
two little gutters in the inner ends of the two lids which open into a 
larger drain emptying into the nose. Each eye is moved in different 
directions by six little muscles, but the only ones of special interest to 
us are the two inner straight muscles, that are attached one to the out- 
side of each eye next the nose, which converge the two eyes upon near 
objects. 

For the sake of clearness we will make two general divisions of our 
subject, and consider the eye first in its relation to weak sight ; and 
secondly in its relation to blindness, although they will overlap one 
another at certain points. 

Weak Sight. 
Weak sight is that condition of affairs in which, while there is no 
evidence of disease, the eyes are nevertheless unequal to the perform- 
ance of their legitimate work. The acuteness of sight for ordinary 
distant objects is sometimes below the standard, and sometimes not, 
but, whether it be or not, any continuous effort at near work, as read- 
ing, writing, sewing, etc., is impossible, and always brings on a certain 
characteristic group of symptoms. First, a heavy, tired feeling in and 
around the eyes is observed, and then the letters or stitches become 



THE CAKE OF THE EYES. 9 

indistinct. After a rest of a minute or two, they can be again seen 
plainly, only to become blurred even more and in a shorter time than 
before. A repetition of these attempts causes pain and watering of the 
eyes with redness of the balls and edges of the lids, often headache, and, 
in some cases, a disturbance of the general health, more especially the 
nervous functions. If attended to promptly, it can nearly always be easily 
relieved ; but if it be neglected and nothing done for it, perseverance in 
near work is liable to cause such sensitiveness and irritability of the 
eyes as to render them not only practically useless, but a constant 
source of annoyance and discomfort in the ordinary lights we must 
daily encounter. It is exceedingly common (and through heredity 
becoming more so every day), and, while not productive of blindness, 
interferes seriously with the practical use of the eyes, as we have just 
said. It is, moreover, very often met with in the young during school- 
life, when it prevents their studying with ease and comfort, if they can 
at all, and by so doing obstructs the formation of the habit of study, 
which in the average boy demands every encouragement, thereby affect- 
ing injuriously the character, probably for life. Such being the case, 
and the remedy for these troubles being very simple and easily applied 
when once they are recognized and their true nature appreciated, the 
Board of Health regards it as of prime importance that the public 
should be put in a position to recognize and appreciate them. 

Advice to intelligent people is much more apt to be taken if accom- 
panied by the reasons for it, and they are, besides, much more likely to 
be interested in a subject if it can be explained and made clear than 
they would be in a mere didactic statement of bald, unillustrated facts. 
Therefore, as interest in these important matters on the part of the peo- 
ple is what the Board is especially anxious to create, I shall endeavor 
to elucidate the subject in as simple a manner as possible. 

Weak sight — asthenopia, as it is technically called — is sometimes due to 
a weak and irritable condition of the nervous apparatus of the eye pure 
and simple ; and this form occurs most frequently in young women, who 
are peculiarly prone to functional nervous disturbances. But in a vast 
majority of instances it is caused by an overstrain of the muscles of the 
eye, either those which adjust each eye for objects at different distances, 
or those which turn both eyes in upon near objects. This overstrain 
may be, and sometimes is, due to simple weakness of these muscles, as 
often occurs during convalescence from severe attacks of illness, in which 
cases it is only temporary ; but it is nearly always a consequence of the 
faulty shape of the ball, causing certain optical defects or errors in re- 
fraction, as they are usually called. 



10 THE CARE OF THE EYES AND EARS. 

In order to understand these optical defects it is necessary to first 
understand what is a correct eye, and how we see with it. The know- 
ledge of a few facts in regard to the nature of a convex lens will render 
this easy. 

A convex lens is a body of some transparent material, usually glass 
as we see it, flattened from side to side, thicker in the middle than at 
the edges, with its faces having the curvature of part of a sphere or 
round ball. A familiar example is an ordinary magnifying- or sun- 
glass. Its peculiar property is that rays of light emanating from any 
object, after passing through it, are brought together again in the same 
relation to one another as they started from the object, and a picture 
or image of it is thereby produced. The point at which this union is 
effected is called the focus of the lens. The more convex the lens, the 
stronger it is and the shorter is its focus. The action of a convex lens 
can be interestingly illustrated in this way: Having closed all the 
doors and windows of the room except one in order to shut off the 
side lights, take a magnifying-glass— or, if not convenient, the spec- 
tacles of the oldest person in the house, they being convex lenses — 
and, holding it immediately opposite the window about three feet from 
the wall, gradually approach it thereto, and you will presently see 
come out on the wall a distinct picture, turned upside down, of the sky, 
trees, and other objects outside. 

If you will turn to the diagram of the eye, you will recall that the lens 
is situated immediately behind the iris and opposite the pupil, and that 
the sensitive retina is the coat nearest to it, being the innermost of the 
three. Now, as the convex lens of glass held opposite the window of 
the darkened room makes a picture of outside objects on the wall, just 
so does the convex lens in the dark chamber of the eye placed opposite 
the only window, the pupil, make a picture of outside objects on the 
retina, which in the normal eye is exactly at its focus. The impression 
thus made upon the retina is transmitted to the brain by the optic nerve, 
and the act of vision is complete. 

In what has been said about rays of light reference has been had 
only to rays from distant objects, which are always practically parallel 
to one another. It is an optical fact that rays emanating from objects 
nearer than twenty feet sensibly diverge from one another, and that the 
nearer the object the more divergent they are. A lens having only so 
much power to concentrate light, it is evident that divergent rays can- 
not be brought to a focus as soon as parallel ; in other words, that their 
focus must be farther from the lens. This being true, how is it that we 
see near objects distinctly, as the retina cannot be set back to this new 



THE CAEE OF THE EYES. 



11 



focus ? By an increase in the thickness or convexity of the lens, which, 
as you remember, shortens the focus. This is what is called the accom- 
modation of the eye, and it is effected in the following manner : The 
inherent tendency of the lens-substance, which is exceedingly elastic, is 
to assume a more globular form, but, enclosed in a sac, it is suspended 
or swung in the larger concentric circle made by the ciliary muscle by 
means of a connecting band (see diagram), and as long as the muscle 
is at rest the sac is kept upon the stretch and the lens more or less 
flattened. As soon, however, as the muscle contracts, being a ring, 
it must become smaller, and in so doing necessarily slacks the sac, 
thereby allowing the lens to follow its natural bent and bulge more in 
the middle. This is clearly shown in Fig. 1, where one half represents 




Fig. 1. 

the position of the parts when the eye is at rest or adjusted for dis- 
tance, and the other half when the muscle has contracted and it is 
adjusted for near objects. It will be observed that the edge of the 
lens is nearer to the muscle in the latter, and that therefore the sus- 
pensory ligament or band must be slacked. 

In this way each separate eye is accommodated for different distances, 
but, as we always use the two eyes together, the adjustment is not com- 
plete unless they are both fixed upon the object. This convergence is 
made by the inner straight muscles attached to the sides of the balls 
next the nose, and the nearer the object of course the more must the 
eyes be turned in. 

Thus we see that the adjustment of the eyes for near objects is 
accomplished by a muscular effort on the part of two sets of muscles, 
and that the nearer the object the greater the effort required of both, 
so that there is always a harmony of action between the two. If you 
will look steadily at a pencil or your finger held less than six inches 



12 



THE CARE OF THE EYES AND EARS. 



from the eyes, you will be distinctly conscious of this effort, which if 
kept up becomes painful ; but at the ordinary distance of ten or twelve 
inches it is not perceptible in eyes of the proper shape. But variations 
from this proper shape are exceedingly frequent, and, as said before, 
defects in form are nearly always at the bottom of weak sight. They 
are, of three kinds. In Fig. 2 the line X Y represents the retina in a 




Fig. 2. 



normal eye at the proper distance from the lens, but the eye may be 
too short, with the retina too close to the lens, A B, causing over-sight or 
far-sight ; or it may be too long, with the retina too far from the lens, 
M N, causing near-sight or myopia; or the clear front, the cornea, may 
be irregular in its curvature, producing what, for want of a common 
name, will have to be called by the technical term of astigmatism. An 
easy way to remember these errors is to bear in mind that the short 
eye has long sight, and the long eye short sight, while the astigmatic 
eye does not have good sight at any distance. 

Over-sight or Far-sight is by long odds the most common of these 
optical defects, certainly in this country, and it is therefore the most 
frequent cause of weak sight. But how does it cause weak sight ? you 
will ask. By adding to the strain upon the accommodation. In the 
normal eye, the retina being exactly at the focus of parallel rays (X Y, 
Fig. 2), no effort whatever is required for distant vision, and the accom- 
modation for near objects can be made without trouble ; but in the 
short eye (A B) the focus must be shortened even for distance, and con- 
sequently just that much work must be added to what is usually re- 
quired of the little muscle ; and that is too much for it, so it breaks 
down, and we have precisely what we Avould expect from muscular 
fatigue — viz. the sense of weariness and heaviness about the eyes, the 
recurring dimness of the letters, the aching, and other symptoms cha- 
racteristic of weak sight. Therefore, upon the occurrence of these 
symptoms we would suspect the presence of over-sight, especially if 



THE CARE OF THE EYES. 13 

distant vision were perfect (which would exclude near-sight and astig- 
matism), although it is not perfect in the highest degrees of over-sight 
itself, because in them the ball is so very short that it is beyond the 
power of the muscle to bring up the focus of even parallel rays to the 
retina. Such cases, however, are comparatively rare. Another effect 
of this over-sight is that the harmony of action between the two sets of 
muscles used in adjusting the eyes, accommodation and convergence, is 
destroyed, and as a result we frequently have crossed eyes, this being 
the cause in over 75 per cent, of such cases. 

The remedy is simple and — if applied early before the eyes become 
chronically irritable — sure. Everything necessary to be done is to 
shorten the focus of the lens in proportion to the shortness of the eye, 
so as to do away with all extra effort — that is, all effort for distance — 
and put the eye on an equality with the normal eye. This is easily 
done by adding on another convex lens of the proper strength in the 
shape of spectacles. 

Near-sight or Myopia is a subject of peculiar interest to the custo- 
dians of the public health. It is just the opposite, optically, of far- 
sight or over-sight, and, while the conditions causing the latter are 
always congenital, in near-sight they originate, as a large number of 
investigations show conclusively, between the ages of six and sixteen, 
or during school-life — rarely before and rarely after that period.* 
Heredity exerts a powerful influence in its production, a considerable 
proportion of the children of one near-sighted parent being apt to 
develop it, but it is very often acquired when there is no predisposition 
to it. When once established it is incurable. It can to a large extent 
be prevented by proper care on the part of parents and teachers during 
the period named. I shall therefore, as the representative of the Board 
of Health in this matter, endeavor to set forth clearly the true cha- 

* It appears from the German statistics that the percentage of myopia, 
beginning with less than one half of 1 per cent, during the first half year 
of school-life, increased gradually from year to year to over 60 per cent, on 
an average in the highest class, in one instance going as high as 79 per cent. 
The Germans, however, are a peculiarly near-sighted race, and in this 
country the percentage of short-sight is only about half as great. An in- 
teresting result of the American observations is the fact that myopia is very 
rare among the negroes ; all of which demonstrates in a general way the 
influence of literary culture and of heredity in the causation of this trouble. 
The investigations further show that the development of near-sightedness 
is in a direct ratio to the prevalence of the unfavorable conditions referred 
to in the text, and that it increases in degree, after it has once started, from 
year to year. 



14 THE CAEE OF THE EYES AND EARS. 

racter of the affection, with the means of its prevention, in order to 
save our people as far as possible from becoming any more " bespec- 
tacled " than is absolutely necessary. 

As mentioned above, near-sight is due to an elongation of the eye- 
ball displacing the retina backward, so that parallel rays come to a 
focus in front of it, and only divergent rays — from near objects — come 
to a focus exactly on it, and they only, therefore, can be distinctly 
seen ; so that the causes of short-sight are to be found in everything 
that has a tendency to increase the length of the ball. 

Merely mentioning the fact that anything injurious to the general 
health, by weakening the resisting power of the tissues of the eye in 
common with those of the rest of the body, assists in producing this 
elongation, and calling attention especially to the execrable ventilation 
of many school-rooms as a most active agency in this category, I will 
point you particularly to those causes acting directly through the eye 
itself. 

It is now regarded as an established fact that the continued tension 
of the muscles of adjustment (accommodation and convergence) is the 
principal factor in the production of near-sight ; and, it having been 
explained above that the nearer the object to the eyes the greater the 
tension or strain upon both these sets of muscles, it follows that every- 
thing having a tendency to cause the undue approximation of objects 
on which the eyes are continuously used during childhood assists in 
the origination of this condition. I say " in childhood," because, as 
we have seen, it nearly always begins during that period ; and it does 
so for the reason that the tissues of all growing and immature animals 
are more soft and yielding than when they have attained the firmness 
of maturity — another reason for special attention to their general health 
at this time. 

Since a large part of childhood, and particularly that part of it in 
which the eyes are used most on near objects, is passed in the school- 
room, it is there that we would naturally seek the causes of this trouble. 
And it is there that they are generally found. School-children are 
often compelled to hold their books too near — that is, nearer than ten 
inches — because the amount of light is insufficient. This question of 
plenty of light of good quality (the best is direct from a northern sky) 
in the school-room is of the highest importance, and cannot be im- 
pressed too deeply upon those having such matters in charge. In a 
general way, it may be said that there should always be enough light 
to enable a child to read on a moderately clear day fine print in the 
darkest corner of the room at the distance of a foot. And the direc- 



THE CARE OF THE EYES. 15 

tion from which it comes is also important. Preferably, it should come 
from the left and above, so that, while illuminating the page, it may 
not fall upon the eyes nor cast a shadow of the hand in writing. The 
next best direction is from behind, then from the right, but never from 
in front. The children should always look at a dead wall. I append 
an admirable statement of the " Eequirements of the Model School- 
room," * copied in the Sanitarian for October, 1885, from City School 
Systems of the United States, and earnestly commend it to all school 
boards and others having in charge the building of school-houses. It 

* "Eequirements of the Model School-room. 

"(1) Shape. — It should be oblong, the width being to the length about as 
three to four, with the teacher's platform at one end. 

"(2) Size. — For primary or grammar school, with register of 54 pupils and 
attendance of about 50, the room should be about 33 feet long, 25 wide, and 
13 high, which gives practically upward of 200 cubic feet of air and 16J square 
feet of floor-space to each pupil. 

"(3) Lighting. — Four windows on the left of the pupils as they sit, the tops 
being square and not more than six inches from the ceiling, the bottoms 
being at least three and a half feet from the floor, equally spaced, not 
grouped, with transom sashes hung at the base above the sliding sashes. A 
window or two in addition at the back is admissible. The size of the win- 
dows on the side, taken collectively, should equal at least one-sixth of the 
floor-space. The highest authorities in school hygiene require 300 or 350 
square inches of glass for each pupil. 

"(4) On the side opposite the windows two doors, with transom windows 
above hung at the base, and between these transom windows, and on the 
same line, two more windows of the same kind and hung in the same 
manner. 

"(5) The wall should be slightly tinted, but not the ceiling. 

"(6) A black-board may be between the doors, but a sliding black-board 
back of the teacher's platform, or a portable one on the platform, in accord- 
ance with the German idea, would perhaps be better than the profusion of 
wall black-board now in vogue among us. 

"(7) Location of Seats. — The main rule to be observed in the placing of the 
seats is to carry them as far as possible toward the window side of the room, 
and as far as possible from the opposite side; the aim being to make the 
arrangement such that the distance of the outer row of desks from the 
windows shall not exceed once and a half the height of the top window 
from the floor." 

Proper height of seats and desks for different ages, as approved by the 
Boards of Health of New York and Chicago : 

From 7 to 9 years, top of desk 23 inches, front of seat 12J inches. 
9 to 11 " " " 24 " " " 12| " 

" 12 to 14 " " " 25| " " " 14 

" 15 to 18 " " " 27* " " " 15J " 



16 THE CARE OF THE EYES AND EARS. 

need not be more expensive than the ordinary plan, except in the 
matter of windows ; and I am sure no one will grudge the children 
under his care in this respect the very slight additional cost necessary 
to supply them with light enough for the comfortable and safe use of 
their eyes. 

The light being sufficient, the print may be bad or too small, though 
this danger has now been largely eliminated by the spread of know- 
ledge on this subject and the active competition of publishers. 

Sometimes the proportion between the height of the seat and that 
of the desk is such as to bring the book too near, as a low seat with a 
high desk. 

Occasionally the seat has no back, so that from sheer fatigue the 
child is constrained to lean forward on the desk to rest himself. 

Any of these things may cause this dangerous approximation, and 
not infrequently it is made more hurtful by a system of instruction 
which requires it to be kept up continuously for hours at a time. 

The approximation of the book to too near a point is dangerous, 
because, as we. have seen, it necessitates a strain upon the muscles of 
adjustment. That strain excites an increased flow of blood to the eyes 
to furnish the power for the extra work. The increased amount of 
blood causes dilatation of the blood-vessels and congestion, which con- 
duces to the softening and degeneration of the coats, especially of the 
outer, tough, white coat, whose peculiar function is to preserve the 
shape of the ball. At the same time it has a tendency to augment the 
volume of the humors within the eye. This increase in the humors 
adds to the pressure from within outward, causing the softened coats 
to give way or bulge slightly at their weakest point, which is at the 
back, around the entrance of the optic nerve. But the principal factor, 
probably, in the production of the bulging is the squeezing of the ball 
by the muscles which move it, as they are put greatly upon the stretch 
when the eyes are turned in much. The walls, having once begun to 
give way, become thinner and less able to resist, and, the same causes 
continuing to act, the near-sight is apt to increase. If the bulging 
extend beyond a certain point, the two inner and more delicate coats 
become very much damaged, and sometimes destroyed, by the excessive 
stretching. Occasionally the retina, unable to follow farther, is de- 
tached from the coat lying under it, and then total destruction of sight 
is only a matter of time. So that short-sight is nearly always accom- 
panied by a diseased condition, often progressive in character, that 
may, and not infrequently does, end in blindness, making our duty to 
give warning of its dangers the more imperative. 



THE CARE OF THE EYES. 17 

It is the duty of the teacher to see to it that the faulty conditions as 
to light, etc. above indicated are corrected, so far as lies in his power. 
He should, besides, make it a point to frequently interrupt the studies 
by various appropriate exercises (now common in well-managed schools) 
which will permit a rest of the eyes, and by frequent recesses. Parents 
also should exercise supervision iu these matters at home, and in 
addition to carrying out the instructions given under the head of 
" General Directions," they should forbid too much study and reading, 
especially if their children be precocious and disposed to be bookish, 
and encourage them to outdoor life. This is often the more urgent be- 
cause such children are apt to be feeble and delicate in constitution. 

Owing to the presence of disease in so many near-sighted eyes, they 
are very often sensitive, irritable, and painful. The ordinary symptoms 
of weak-sight too are frequently complained of, even when the morbid 
changes are not very marked, they being due to the overstrain of the 
muscles of convergence, caused by the necessity of holding the book 
•too near in order to make out the letters. 

Attention to the presence of this defect will most likely be called by 
the child's inability to read figures on the black-board or in some similar 
way. Either a high degree of over-sight or the irregular error, astig- 
matism, may cause this as well as short-sight, but the difference between 
them and the true myopia is that in the last the sight for objects held 
near enough is generally unusually acute, while in the first two it is apt 
to be more or less proportionally bad at all distances. 

When once the fact becomes known, the eyes should be scrupulously 
guarded, and upon any complaint (or without waiting for it if the child 
seems to be very near-sighted) the advice of a competent physician 
should be promptly sought, so that he may give fully and explicitly 
the proper directions for the treatment and care of the eyes, including, 
if the state of the case warrant them, the proper concave glasses. Con- 
cave glasses, being the reverse of convex, lengthen the focus to suit the 
(short-sighted) long eye. It is of peculiar importance that accurately- 
adjusted glasses should be worn in these cases, because they not only 
permit the removal of the book to a safe distance, thereby assisting 
greatly in checking the progress of the affection, but they also enable 
the child to imbibe unconsciously a vast amount of knowledge that 
would otherwise escape him. At the same time, being in a position 
to see and enjoy the world around him, he would be encouraged to 
use them on distant objects and get away from his books. 

Astigmatism. — The explanation of this error is apt to be so confus- 
ing to any one not quite familiar with optics that I shall not weary 
2 



18 THE CARE OF THE EYES AND EARS. 

you, but will merely mention certain characteristic facts. The astig- 
matic person sees neither distant nor near" objects distinctly, but he has 
the peculiarity of seeing lines running in one direction more clearly 
than others at right angles to them, and these lines are usually vertical 
and horizontal. He is apt to complain of all the . symptoms of weak 
sight, probably in an exaggerated form, with an unusual amount of 
headache, and sometimes other nervous symptoms. Glasses accurately 
calculated, and made (as they must be) for the particular individual, 
render the sight acute, and are often of unspeakable comfort. 

Old Sight cannot be considered, strictly speaking, as an optical 
defect, but it is merely one of the changes which come to us all with age. 
The lens of the eye becomes stiff and hard, less elastic than in our 
younger days, and consequently when the muscle of accommodation, 
which has also lost some of its vigor, slacks the sac holding it, it does 
not assume the convexity necessary for distinct vision of near objects. 
At the same time, distant vision remains as good as ever, because, as 
you remember, no adjustment is needed in the normal eye for distance. 
It usually makes its appearance between forty and fifty years of age. 
The first symptom is a disposition to hold the book or paper rather 
farther off or to seek a better light, especially at night. After a little 
the symptoms of weak sight come on, and for the same reason that they 
usually appear — viz. overstrain of the muscle, though this time it is not 
due to the shape of the ball, but the consistence of the lens. The 
remedy is found in convex glasses, which by shortening the focus assist 
the accommodation and relieve the strain. It is very important to put 
on glasses as soon as needed, to avoid this strain, not only as a matter 
of comfort, but because the overstraining of old eyes is thought to be 
one of the causes of a most serious and fatal disease of the eye. 

Recapitulation. 
In the preceding pages an attempt has been made to set forth, as 
simply and clearly as possible, certain facts of general interest and 
importance in regard to the eye, especially those bearing upon the 
exceedingly common and troublesome group of symptoms included 
under the general term " weak sight," and upon the nature and dan- 
gers of near-sight. The subject has been dwelt upon — to the point of 
tediousness, some will feel, I fear — because, while of very frequent 
occurrence, and when present very annoying, even to the extent of 
rendering the eyes practically useless, the nature of weak sight is not 
at all understood by most people, nor are they aware that it can in 
most cases be completely relieved by a very simple remedy. Neither 



THE CARE OF THE EYES. 19 

is it generally known that near-sight, often the result of preventable 
causes, is frequently associated with disease that may prove fatal to 
vision, and that special care is therefore required in its management. 
On the contrary, the popular opinion is that near-sighted eyes are 
strong eyes. 

It has been shown that in the normal eye objects are seen by the 
formation of images or pictures of them through the instrumentality 
of the lens on the sensitive retina; that distant objects are seen clearly 
without effort, while near objects are made distinct, by a muscular effort, 
it is true — the accommodation — but one that can be made and kept up 
without fatigue ; and that the two eyes are held upon near objects com- 
fortably by the muscles of convergence. It has also been explained 
how certain departures from the normal in the shape of the eyeball 
will bring about an overstrain of one or both of these sets of muscles, 
causing weak sight, Attention was called to the short eye, causing 
over-sight or long-sight, as by odds the most frequent cause of weak 
sight, though certain nervous conditions, weakness of the muscles from 
sickness, and strain of the muscles of convergence in short-sight, were 
mentioned as being sometimes responsible for it. It has been further 
made plain that near-sight, or myopia, is the result of an elongation 
backward of the globe ; that it nearly always originates during school- 
life or between the ages of six and sixteen ; that it is often progressive 
in character, and is then associated with diseased conditions which may 
lead to total loss of sight ; that its cause is too great tension or strain 
of the muscles of adjustment, resulting from too much study or from 
unfavorable surroundings, necessitating an overstrain by requiring too 
near an approximation of the object ; and, finally, that it is largely 
preventable by proper care. 

General Directions. 

The directions for the* proper use of the eyes follow, almost as a mat- 
ter of course, from what has been said. 

Always have plenty of light. Economy in light is very poor economy. 
Many of the most intractable forms of weak sight I have seen have re- 
sulted from the use of the eyes by a bad and insufficient light. Any 
good, white, steady light will answer, provided it is bright enough. The 
German student's lamp, looked at from every point of view, expense 
included, is probably the best light, but any good lamp with a large 
wick, that is kept clean and well-trimmed and filled with good oil, will 
do very well. Avoid flickering gas-jets. If you prefer gas, see that 
the flame is steadied by an argand burner or a transparent globe with 



20 THE CARE OF THE EYES AND EARS. 

a large opening below. The light should come from behind and the 
left, so as to illuminate the page and not the eyes. Nothing is more 
irritating than a number of lights falling upon the eyes from different 
directions, as the jets in a church or public hall, and those with sensi- 
tive eyes should never attend such places at night without the protection 
either of dark glasses or a shade. 

Never read by twilight. I have in mind now a young lady of 
prominence who, for one imprudence in this respect, forfeited the 
use of her eyes for months, not to mention the positive suffering she 
endured. 

Do not read lying down. Owing to the position, the eyes are more 
than usually full of blood, and the muscles are unduly strained because 
of the practical impossibility of holding the book squarely before the 
eyes. For a similar reason, do not employ the eyes in a stooping 
position ; it obstructs the return flow of blood. from the head and eyes. 
" Carry the book to your eyes, and not your eyes to the book." 

Eschew the pleasures of book or newspaper while riding, unless the 
vehicle be very steady. The work of adjustment is greatly increased 
by the shaking of the letters ; the eye has " to take them on the fly," 
as it were, and it is very fatiguing. It should never be done, even on 
the smoothest railway, if the eyes are not perfectly strong. 

Never sew on black at night. Black absorbs so much light that 
no ordinary artificial source can afford enough for its proper illumi- 
nation. 

Whenever the eyes become tired and uncomfortable stop work and 
rest them a while. If you persist in using them after the warning, 
you will be apt to suffer for it. If the fatigue and discomfort be so 
marked as to amount to weak sight, seek advice from some competent 
physician, who will nearly always jmt you in the way of obtaining per- 
manent relief. 

If old enough to wear specs, put them on 9s soon as you feel the 
need of them ; which is to say when you catch yourself holding your 
book farther off in the day and abusing the lamp and the print at 
night. 

Plenty of sleep is important. When the eyes are weak, it is a 
necessity. Should you have children, observe them while using their 
eyes, and if they hold the book too near or if they complain of them, 
examine into the matter carefully. By following the directions given 
at the end of this discourse, you can form some idea of the trouble 
yourself, though only the skilled physician can relieve it. Being am- 
bitious and studious, do not urge them to still greater tasks for the 



THE CAKE OF THE EYES. 21 

gratification of your own pride, and run the risk of irreparably dam- 
aging their eyes or ruining their health for life ; but judiciously curb 
their enthusiasm, impressing upon them the important truth that the 
sound body is as necessary as the cultivated mind. I have been shocked 
at the folly sometimes exhibited by parents in this respect. 

Glasses. 

Glasses for the young, owing to the peculiar character or the serious 
nature of the defects occurring among them, should always be selected 
by some one thoroughly familiar with the subject. Says a well-known 
writer : " The selection of glasses for short-sight requires great care, as 
much harm may be done by using those that are too strong or that are 
not properly fitted to the eye. In many cases the plan of ' trying ' the 
various glasses on the optician's counter — or, far worse, in the peddler's 
box — is about as rational and safe as it would be, in case of sickness, 
to try the contents of the various bottles on the druggist's shelf with- 
out a prescription." But in old sight it is not so serious a matter, and 
at the end I append a simple rule for the selection of such glasses that 
may prove a help to some of my readers. 

Spectacles are, as a rule, better than eye-glasses, because the lenses 
are kept in the right position more easily, though the latter are often 
very handy, especially when the specs become mislaid, as they fre- 
quently do when not worn constantly. In such cases, if expense be 
not an item, it is very convenient to have both. The frames are a 
matter of taste only, provided they fit the face properly, so as to put 
the centre of each lens opposite each pupil and the right distance from 
the eye. Steel frames are most generally worn, but for constant use in 
summer some non-corrosive material is better, and even gold is more 
economical in the long run. 

All glasses are equally good, provided they are equally homoge- 
neous and transparent, the only difference between them being in the 
curvature of their surfaces. " Pebbles," while much more costly, have 
no special virtues over glass, other than greater hardness, and conse- 
quent less liability to scratch, and a little less weight in the higher 
numbers. Quite often they are much inferior to glass, because, being 
cut from a natural and peculiar product, fluor-spar, they must be made 
with great care or they are much worse than glass, and that care is not 
always bestowed on them. Be not deceived by the oily-tongued venders 
of spectacles travelling through the country. The truth is not in them, 
and they usually charge from two to ten prices. If you are so unfor- 
tunate as to need glasses, and feel equal to selecting them for yourself, 



22 THE CARE OF THE EYES AND EARS. 

buy them from some optician or jeweller in your nearest town whom 
you know to be a man of character. 

From $1.50 to $2.50 is ample for the best glasses in good steel 
frames, and from $5 to $10 in gold, unless the lenses be of the peculiar 
kind required in astigmatism or a combination of different sorts. 

Blindness. 

In considering the care of the eyes in its relation to blindness, we 
must deal with the diseases and injuries to which they are liable. For 
a thorough exposition of the subject volumes would be required, such 
has been the progress in this branch of medicine ; but of course in a 
publication of this kind it is only intended to call attention to certain 
facts in connection with them that ought to be in the possession of every- 
body, as a general knowledge of them would annually save this most 
precious of the senses to very many. 

Having already, in the first division of our subject, dwelt upon the 
diseased conditions associated with near-sight which sometimes cause 
the loss of vision, no further allusion will be made to them. 

By long odds, the most frequent of the diseases practically interest- 
ing to us is an inflammation of the delicate membrane covering the 
front of the ball and lining the under surfaces of the lids, called 
the conjunctiva. There are many varieties of this, but the symptoms 
common to all of them are redness of the eyes with more or less swell- 
ing of the lids and a discharge of mucus or matter. The severity of these 
symptoms is an index of the gravity of the attack. The discharge is 
highly contagious, and, as the matter from a mild case may excite an 
attack of dangerous severity in another, the most scrupulous cleanli- 
ness should be observed, and no one should be permitted to use the 
same washbowl or towels as the patient. 

A familiar illustration of this class of diseases is the common " sore 
eyes " which goes through the country every few years, and which, it 
may interest you to know, is technically known as catarrhal conjunc- 
tivitis or catarrhal ophthalmia. It is generally of a mild type, with a 
tendency to recovery, and is, for the most part, treated without the aid 
of a physician, and usually with success. But just here I must sound 
a note of warning against the use of any preparation of lead. I men- 
tion this, because if the clear " watch crystal " becomes ulcerated, as it 
sometimes and not very infrequently does in this disease, the lead be- 
comes deposited on the rough surface of the ulcer in the form of its 
insoluble carbonate, or white paint. It sticks so closely that it cannot 
be satisfactorily removed without damaging the eye, and is occasionally 



THE CARE OF THE EYES. 23 

the cause of its total loss. I have seen a number of such cases. A 
popular old remedy known as " Thompson's eye-water " is said to be 
one of these lead preparations, and should never on that account be 
used, as it cannot be predicted when these ulcerations may occur. 
Any simple astringent, as alum-water, a teaspoonful to a pint, or borax- 
water, twice as strong, a few drops in the eyes three or four times 
a day, or simply bathing the closed eyes for fifteen or twenty min- 
utes at a time several times a day with water as hot as can be borne, 
will answer ; but if the eyes become decidedly painful and sensitive to 
light, and especially if the transparent part appear smoky or rough, 
seek your physician immediately, as the eye is in danger and more 
careful treatment is necessary. 

The gravest of this class is the inflammation which comes on during 
the first week of life, usually in the first three or four days after birth. 
It is the most frequent cause of hopeless blindness, 80 per cent, of the 
inmates of the blind asylums of Great Britain having lost their sight 
from it, and in the United States 32 per cent, of those blind from pre- 
ventable disease tracing to it. And the pity is the greater because it 
is very amenable to proper treatment, and this fearful loss of sight 
must therefore be largely attributed to either ignorance or neglect. It 
can be easily recognized by the symptoms common to the class men- 
tioned in the beginning — viz. redness and swelling of the lids, with a 
discharge of matter, occurring shortly after birth. In view of its dan- 
gerous and, in bad cases, rapidly destructive character (twenty-four to 
forty-eight hours sometimes sufficing to compass the loss of the sight), 
no time should be lost in trying breast-milk, rotten apple, tea-leaves, 
alum curd, or other infallible remedies of the monthly nurse, but the 
physician should be called at once. But do not sit idly by doing noth- 
ing until he comes, for good doctors are apt to be busy men, and it 
may be several hours or longer before he can get round, especially if 
it be in the country, and the child's sight may be lost in that time. 
The first thing to do, if only one eye be affected, is to try to prevent 
tbe infection of the good one by matter from the first, and the simplest 
method of doing this is to seal up the good one. Put a piece of soft 
clean cotton over it, and cover the whole with sticking-plaster, special 
care being taken to see that it is securely glued down on the dangerous 
side. For the same- reason the child should, as far as possible, lie on 
the affected side and the hands should be secured. But both eyes are 
nearly always involved from the beginning. As cleanliness is the most 
important part of the treatment, set to work to cleanse, and keep the eyes 
clean, repeating the washing as often as every half hour if necessary. 



24 THE CARE OF THE EYES AND EARS. 

Separating with the thumb and forefinger of the left hand the lids of 
the lower eye (the child lying on his side), let a stream of the borax- or 
alum-water, mentioned above, from a sponge or cloth saturated with it 
run between them upon a folded towel previously placed under that 
side of the head, and repeat until the matter is all washed out. After 
the doctor comes attend carefully to his directions, and carry them out 
to the letter day and night, for in the bad cases of this disease eternal 
vigilance is the price of sight. 

In all those eye troubles characterized by a dread of light, watering 
of the eyes, particularly on exposure, and pain, especially if it extend 
to the brow, temple, side of nose, and perhaps run up into the head, 
very important structures are almost surely involved and medical aid 
should be obtained without delay. Irreparable damage may result from 
waiting only a few days. 

Elderly persons who observe rings or rainbows around the lamp, 
and who suffer from occasional attacks of dimness of sight, are threat- 
ened with a disease known to oculists as glaucoma. Should the dim- 
ness persist for twenty-four hours, especially if accompanied by pain 
in the eye or head, let not another day pass without obtaining skilled 
advice. The results of prompt treatment are among the most brilliant 
in surgery ; absolute and hopeless blindness, often accompanied by 
great pain, is the consequence of neglect. 

Cataract is the most common cause of curable blindness. It is sim- 
ply a cloudiness or opacity of the crystalline lens, so that cataract is 
in the eye, not on it, as we often hear it said. It may occur at any 
time of life, but nearly always at the two extremes, being often con- 
genital, but usually one of the results of age. A gradual failure of 
sight, presenting the peculiarity of being better in a dim than in a 
bright light, at twilight than in the middle of the day, is very sugges- 
tive — quite characteristic indeed of certain partial cataracts occurring 
in the young ; but the nature of the disease is rendered certain by the 
appearance of the pupil, which, instead of being black as in health, is 
gray or white. The pupils of all old persons are somewhat grayish, 
from the natural hardening of the lens, but their sight is good. The 
blindness is relieved by the removal, by a delicate surgical operation, 
of the opaque lens ; and such has been the progress in this branch of 
medicine that, taking the average, over 90 per cent, are restored to 
sight. It is peculiarly important that the cataract of infancy and 
childhood should be removed during that period of life, because by 
obstructing the light it prevents the development of the nervous appa- 
ratus of the eye from want of exercise. Neglect to have it done is the 



THE CARE OF THE EYES. 25 

more inexcusable on the part of parents because the operation is not a 
difficult one, and is not often followed by bad results. 

Tobacco Amaurosis is a form of blindness that results from the ex- 
cessive use of tobacco. It is an affection of the optic nerve, and there 
are no visible changes in the eye, the only symptom being a gradual 
failure of sight. Abandoning the habit, sight is almost sure to return 
under a tonic treatment. 

Floating Specks — or Muscat Volitantes, as they are technically called 
— are small spots of various shapes, or more or less translucent bodies, 
singly or in strings like beads, which are seen floating about in the 
field of vision upon looking at a bright surface. They are merely 
shadows cast upon the retina by minute opacities in the vitreous humor, 
and, sight being good in other respects, they mean nothing. Any one 
can see them by looking at the sky or a white wall through a pin-hole 
in a card. 

Color-Blindness is a peculiar affection which, while it may be caused 
by disease, is generally congenital. Sight for ordinary purposes is of 
normal acuteness. but certain colors, most commonly red or green, can- 
not be correctly distinguished. It is very much more frequent among 
men than women (3 or 4 per cent, to much less than 1 per cent.). 
Practically, it is interesting and important in its relation to the 
employees of railways and steamboats, who are governed by colored 
signals. The question of life and death being involved in the correct 
reading of the signals, all such employees should be carefully tested in 
this respect before being taken on. 

Accidents and Injuries. — Certain wandering denizens of the air, such 
as moths, cinders, gnats, etc., frequently find their way into the eyes, 
and few of us have not felt " what small things are boisterous there." 
Entering with comparatively little force, they are not imbedded in the 
tissues, but are usually found lying between the ball and one or the 
other lid, generally the upper. This being so, they are sometimes very 
easily removed by pulling down the upper lid over the lower, so as to 
wipe the under surface of the former by the lashes of the latter. Fail- 
ing in this, it is not worth while to waste time on flaxseed, the popular 
remedy — which acts, if at all, by getting between the lid and ball, lifting 
it off, thereby giving the tears a better chance to wash the foreign body 
out — as prompt relief can nearly always be secured by a little simple 
manipulation on the part of a friend. It is done in this way : Place 
the point of an ordinary lead-pencil or other small rod horizontally on 
the upper lid about half an inch from its edge ; grasp the lashes firmly 
with the other hand, hold the pencil steady, tell the patient to " look 



26 THE CARE OF THE EYES AND EARS. 

down," and just as he does so turn the lid quickly over the pencil, and, 
nine times out of ten, you will find the mote or cinder sticking to 
it. Having found it, wipe it gently off with either a handkerchief, a 
twisted piece of paper, or, best of all, a small soft brush made by wrap- 
ping a little cotton around the end of a match. 

Workers in metal and stone are liable to more serious invasions by 
flying fragments of the material in which they work. These minute 
pieces of steel or stone fly off with so much force that very often they 
are imbedded in the clear front of the ball. An attempt may be made 
to remove them with the brush just spoken of or with a bluntly and 
smoothly-pointed stick of soft wood ; but if it is not easily and quickly 
done a more skilful hand should be sought, as repeated efforts might 
seriously damage the transparent cornea. Prevention being better than 
cure, such artisans should always wear while at work strong eye-pro- 
tectors. 

Quite often these foreign bodies are of sufficient size, and strike the 
eye with force enough, to penetrate its walls and let out some of its 
humors, the most common being fragments of gun-caps and splinters 
of wood which fly up in chopping. Injuries of this character are of 
such serious import that no intelligent person would fail to shift, as soon 
as possible, the responsibility on his medical attendant. There is some- 
times in these cases a special reason for seeking his help. If the cut 
through the coats lie in what is called the " dangerous region," which 
is a belt of the white of the eye about one-eighth of an inch wide 
lying immediately around the colored part, and especially if the mis- 
sile be still within the ball, there is great danger of exciting in the 
sound eye the dreaded sympathetic disease, which, when once estab- 
lished, is practically hopeless, causing nearly always complete and ir- 
remediable loss of sight. 

Not seldom the eyes are injured by caustics of one kind or another, 
the most frequent being unslaked lime in fresh mortar. In such cases 
a little castor or sweet oil should be immediately dropped into the eye, 
and then the lime washed out with water. 

Tests of Vision. 

In the types below numbered 1 and XX. we have the tests respect- 
ively for near and distant vision. The perfect eye should distinguish 
No. 1 at one foot, and No. XX. at twenty feet, the retinal images of 
the two being of the same size at those distances. 

The power of accommodation being normal, No. 1 should be read, 
with an effort, as near as three inches at the age of ten ; four inches at 



THE CARE OF THE EYES. 27 

twenty ; five and one-half at thirty ; and eight at forty. When this 
" near point " recedes beyond nine inches, which it usually does about 
forty-five, it is time to put on spectacles. The rule for their selection 
is simply, in a few words, to put on a convex glass strong enough to 
bring it up again to nine inches. If nearer than that, the glass is apt 
to be uncomfortably strong, while if it is not brought within ten inches 
it is not likely to afford complete relief, especially at night, when a 
rather stronger lens is needed than will answer under the brilliant 
illumination of daylight. 

A person who can read No. XX. at twenty feet, and cannot read 
No. 1 as near as he ought at his age, is almost certainly moderately 
far-sighted. 

One who can read No. 1 as he ought, but cannot make out No. XX., 
is moderately near-sighted. If No. 1 be very distinct at a nearer point 
than one foot while distant vision is very bad, the person has myopia 
of a higher degree. 

One who can distinguish neither at the proper distance is either 
astigmatic or very far-sighted — or over-sighted, as now appears to be 
the better term — or very near-sighted. In astigmatism and far-sight 
both near and distant vision are -relatively much the same, equally 
good or bad. In high degrees of near-sight distant vision is propor- 
tionally very much worse. 

No. 1.* — Diamond. 

The place of our retreat was in a little neighbourhood, consisting of farmers, who tilled their own 
gTounds, and were equal strangers to opulence and poverty. As they had almost all the conveniences 
of life within themselves, they seldom visited towns or cities in search of imperfluitiea. Remote from the 
polite, they Btill retained the primaeval simplicity of manners ; and frugal by habit, they scarce knew 
that temperance was a virtue. They wrought with cheerfulness on days of labour, but observed festi- 
vals as intervals of idleness and pleasure. They kept up the Christmas carul, sent true-love knots on 
Valentine morning, ate pancakes on Shrove-tide, showed their wit on the first of April, and religiously 
cracked nuts on Michaelma3eve. Being apprised of our approach, the whole neighbourhood came out 
to meet their minister, dressed in their fine clothes, and preceded by a pipe and tabor ; a feast also was 
provided for our reception, at which we sat cheerfully down ; and what the conversation wanted in wit. 



XX. 

Y A C E G L 



* This type is really 1J and should be read by the normal eye as far as one foot 
and a half, but practically it will answer very well. 



THE CARE OF THE EARS. 



Considering man merely as a constituent element of the community, 
deafness is not so serious as blindness ; but in its relation to the happi- 
ness of the unfortunate individual it is generally regarded by those 
having opportunities of observation as the worse of the two. 

The deaf never receive the sympathetic consideration universally 
accorded to the blind on account of their physical helplessness, but, 
on the contrary, are often treated with impatience, if not with positive 
harshness. In addition, they are frequently harassed by subjective sen- 
sations — noises of various kinds, " so exquisitely distressing," says 
Politzer, the greatest authority on the ear, "as to undermine often 
both the physical and moral powers of the individual, and in some 
cases even to lead to suicide." Their dispositions suffer in consequence, 
and they are apt to become sensitive, suspicious, and reserved. This 
is peculiarly the case with those who lose their hearing in child- 
hood while their moral natures are even more soft and pliant than their 
physical bodies. So deafness is very much more of an affliction than 
those with good hearing are prepared to admit. 

The ear is made up of three divisions : a sound-collecting, a sound- 
transmitting, and a sound-receiving apparatus, 

With the first of these every one is familiar in the peculiarly-shaped 
external ear or auricle. The waves of sound, having been collected by 
this, traverse the auditory canal, which is about an inch and a quarter 
long, and fall upon a delicate membrane stretched tightly across the 
inner end of it. This, in ordinary conversation, is often spoken of as 
the " drum of the ear," but it is, in fact, only the drum-head, or tym- 
panic membrane, the drum being a cavity with other parts in addition. 
Fastened to the inner surface of this drumhead is the first of a chain 
of three tiny bones, called the hammer, the anvil, and the stirrup, from 
their resemblance to those objects, united, as other bones, by joints 
(which sometimes, like them, become stiff) that extend across the 
drum-cavity. The end of the last one, the foot of the stirrup, fits into 
an oval hole in the inner bony wall of the drum, which is the outer 
wall of the labyrinth. It lies immediately in contact with the fluid 

28 



THE CARE OF THE EARS. 29 

filling the labyrinth or inner ear, the sound-receiving apparatus, in 
which fluid the ends of the nerve of hearing are bathed. 

The waves of sound striking against the taut drumhead, it is thrown 
into vibrations, and these vibrations are transmitted through the chain 
of bones to the fluid, and through that to the nerve. This, in brief, is 
the mechanism of hearing. 

Connecting the drum with the throat is a small and crooked tube, 
about an inch and a half long, called the Eustachian tube. This tube, 
as well as the drum itself, is lined with the same mucous membrane that 
covers the throat. Indeed, the drum is, anatomically considered, an 
offshoot from the throat. Such being the case, we would naturally 
expect the drum to suffer with the throat in disease. And the facts 
bear out the anticipation. Fully three-fourths of all cases of deafness 
are attributable to affections of the drum or conducting apparatus that are 
almost invariably associated with similar disease in the throat. Although 
persons hard of hearing may not complain of the throat, it very rarely 
happens that trouble cannot be found there if looked for. When we 
remember how exceedingly common colds and sore throats are, bearing 
in mind that the back part of the nose is a part of the upper throat, 
into which the Eustachian tubes enter, it is very evident why this form 
of deafness is so frequent. 

Inflammations of mucous membranes are always accompanied by 
swelling or a discharge of mucus, generally both ; and, keeping these 
facts in view, it is very easy to understand how these troubles cause deaf- 
ness. The purpose of the Eustachian tube is to keep the drum full of air, 
and Nature has provided that it shall open every time we swallow or 
yawn, so that the air may enter easily if there be need for it. You 
have no doubt often felt the air rush into the ears when blowing your 
nose violently, and felt a roaring in them when gaping widely. 

Sometimes in fresh colds the membrane surrounding the mouth of 
the tube becomes so swollen as to close it, or it becomes stopped by a 
plug of mucus, and then deafness results, because the air in the drum 
is partially absorbed and cannot be replaced. In these cases, when 
the tubes are opened, the restoration of hearing is often magically in- 
stantaneous. It occasionally happens that hearing suddenly returns of 
itself with a sudden snap. The swelling, however, is not always, or even 
generally, restricted to the mouth of the Eustachian tube, but involves 
the length of the tube and the drum itself. Of course swelling in these 
situations, and especially the presence of a viscid fluid in so delicate an 
instrument as the drum, must seriously interfere with its proper work- 
ing. In the acute forms of these troubles relief can generally be af- 



30 THE CARE OF THE EYES AND EARS. 

forded, but when they are allowed to become chronic the changes in 
the tube and drum often assume a permanent character, and complete 
restoration to hearing is then impossible. 

The moral to be drawn from this is, that deafness should be treated 
promptly in the beginning, before irreparable damage is done. This is 
peculiarly true of these troubles occurring in children, as they are then 
exceedingly amenable to treatment, while their neglect is liable to 
eventuate in permanent impairment of hearing. 

In this connection it is proper to make a suggestion to teachers in 
regard to deaf children. They are necessarily at a great disadvantage 
on account of their infirmity, and are often accused of stupidity or in- 
attention when the truth is they cannot hear. So, whenever there is 
any reason to suspect such a thing, carefully test the hearing by con- 
versation across the room with the child's back to you, beginning with 
a whisper and gradually raising the voice, making him repeat each 
word after you. Ascertaining those who are deaf, seat them nearest to 
you, and be patient with them, remembering that one of the frequent 
results of deafness and its accompaniments is an injurious effect upon 
the disposition, and that probably under similar circumstances you 
would not be amiable. 

Earache, a familiar enemy in most families with children, is generally 
due at first to a congestion of the lining membrane of the drum, and 
can usually be promptly relieved by heat. The heat may be applied in 
various ways — by cloths wrung out of hot water, raw cotton heated by 
application to the surface of a tin vessel filled with boiling water, flan- 
nel bags of salt or sand heated in an oven, or, best of all, a steady, 
gentle stream of water, as hot as it can be borne, for twenty or thirty min- 
utes, into the aural canal. Sometimes simply breathing into the ear will 
give relief. The old-fashioned remedy of a boiled onion is not a bad 
one, but never apply poultices to the ear : they are liable, while giving 
temporary ease, to do eventual injury. Abjure spirits of camphor, ker- 
osene, and such remedies ; they do no good, and may do harm. If heat 
fails, call in your physician, and he may try the celebrated new remedy 
cocaine, which sometimes succeeds in relieving pain in the ear, though 
it often fails, being by no means so satisfactory as in eye troubles. 

The earache being neglected, and the congestion of the lining mem- 
brane of the drum going on to inflammation, mucus is poured out just 
as it is from the nose in a fresh cold. The Eustachian tube being also 
swollen, the mucus cannot escape by that, which is the only avenue, 
and so it accumulates, causing fearful pain, until by pressure upon the 
delicate drumhead it brings about its ulceration and perforation, allow- 



THE CARE OF THE EARS. 31 

ing the mucus, which soon changes to matter, to find its way out 
through the external canal. 

Otorrhcea — which means a running from the ear — is the technical 
name given to this state of things, and the cause of it, above set forth 
in detail, is commonly called " a rising in the head." You will note 
that a hole in the drumhead is one of its constant features. Notwith- 
standing the great damage to the ear, it is, owing to its common occur- 
rence and to the fact that some cases do get well (that is, the running 
stops) without any special treatment, often looked upon by parents, and 
occasionally by physicians who have not quite kept up with the times, 
as a trifling matter, their advice in such cases being, " Let it alone and 
he will outgrow it." But it is by no means a trifling matter. If neglected, 
the pus lying in the canal decomposes and becomes very offensive, mak- 
ing the poor child a stench in the nostrils of his associates. To illus- 
trate to what extent this neglect has been carried in some few instances, 
it may be mentioned that living maggots have been found in the ear. 
Another consequence of a want of attention is much greater deafness 
than would have followed prompt treatment. But the evil effects of 
neglect of a running from the ear do not always end here. The dis- 
ease may extend to the bone, and thence to the brain, the dividing-wall 
between the ear and the brain being exceedingly thin, and cause death. 
The wonder is that more fatal cases are not recorded, and, as it is, those 
who are not familiar with the subject would be shocked to know how 
many die from this cause. It need not be said, therefore, that they 
should always receive medical attention. The treatment is simple and 
the services of a specialist are not usually required, any well-informed 
physician being competent to undertake most of them. There cer- 
tainly can be no excuse for not keeping them clean by daily syringing 
out the ear with warm water. All applications to the ear should be 
warm. 

Wax, or a compound commonly called by that name, is a natural secre- 
tion of the walls of the aural canal of a yellowish-brown color and peculiar 
odor, the purpose of which, it is supposed, is to repel wandering insects. 
Quite often it accumulates until, by blocking up the canal, it causes 
deafness ; which, by the way, generally comes on with more or less 
suddenness. It can generally be seen as a dark mass by an inspection 
before an open window, the auricle being pulled upward and backward 
to straighten the canal. It should always be removed, as its presence 
in a hardened mass is apt to prove injurious. Fill the ear nightly with 
warm soda-water (a teaspoonful of cooking soda to a tumbler), letting 
it remain fifteen or twenty minutes for three or four nights, to soften 



32 THE CARE OP THE EYES AND EARS. *. * 

the wax, and then syringe somewhat forcibly with warm water. But, 
unfortunately, this syringing of the ear is not as simple as it sounds, 
nor is it entirely safe in inexperienced hands ; so it is best to go to your 
doctor at once, especially as other changes are often associated with this 
accumulation which will need attention. 

Insects of various kinds frequently get into the ear, and by 
scratching the exquisitely sensitive drumhead with their claws often 
cause frightful pain and the most terrific noises. (I was called from 
my bed" early this morning to relieve marked distress occasioned by so 
harmless a thing as a common house-fly.) When the presence of an 
insect is suspected, the ear should be filled with warm water, which will 
' either run him out or drown him. 

Foreign bodies, such as beads, peas, cherry-stones, etc., in the aural 
■canal " should >never be touched by incompetent hands." If they can- 
not be shaken out by jarring the head, the aid of an expert should 
be obtained, as a number have lost their lives from badly-directed 
attempts to -remove them. 

Injuries to the ear, through rupture of the drumhead, sometimes 
result from the violent concussion due to a loud explosion, as of a large 
cannon. Now and then it is a consequence of a concussion of a more 
homely and every-day character — to wit, a box on the ear. As " there 
are a few well-authenticated instances of death having occurred from 
this barbarous custom," it is superfluous to add that it is " more honored 
in the breach than in the observance." The drum is sometimes injured 
by sharp instruments, such as hairpins, knitting-needles, toothpicks, 
etc., and my reader is warned against scratching the ear in any such 
way. Never put any instrument in the ear except your finger ; you 
cannot get that deep enough to do any harm. 

Before concluding, I must again direct attention to the importance 
of looking after those every-day troubles earache and " rising in the 
head." To their neglect are attributable a great many cases of incur- 
able deafness, and some of death.